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Organization

ORTHO SPORT AND SPINE PHYSICIANS CONYERS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RA'KESHIA BROGDON (CREDENTIALING SPECIALIST)
(404) 941-1233
Entity
Organization

Contact information

Practice address
1292 WELLBROOK CIR NE, CONYERS, GA 30012-8031
(678) 831-7669
Mailing address
5788 ROSWELL RD, ATLANTA, GA 30328-4904
(305) 290-2448

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary

Other

Enumeration date
01/15/2021
Last updated
01/03/2022
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